Advocacy Regulatory Updates

November 2016

Advocacy Regulatory Updates

States: While the vast majority of state legislative sessions adjourned over the summer, regulatory agencies and Departments of Insurance have continued their work into the fall and winter. The following are several items the Government Relations Workgroup (GRW) is monitoring:

• LA proposed regulation 106: As an update to our previous articles (here and here) regarding proposed limited benefit policy replacement regulation in Louisiana, the state’s Senate and House Insurance Committees held a joint hearing to discuss this regulation on Oct. 31. Dental carriers, industry stakeholders and producer groups testified in opposition, reiterating concerns that the proposal would impose burdensome and unnecessary requirements for issuers and producers who offer replacement limited benefit policies. Legislators unanimously rejected the regulation as currently written. The DOI will likely rework and re-promulgate a proposal and the Government Relations WorkGroup (GRW) will continue to monitor the situation. Thanks to Stephanie Berry with Delta Dental of CA, NY, PA and Affiliates for providing this update in the Advocacy Open Forum on Dental Interact.

• SC discount plan regulation: The South Carolina Department of Consumer Affairs (DCA) has issued a Notice of Drafting regulation to clarify registration requirements and processes regarding Discount Medical Plan Organizations (DMPO). In a posting to the GRW, we tracked the changes from the April 2016 version. The new draft amends Section C to remove a requirement that DMPOs notify the Department on a continual basis of changes to representatives or marketers. The word “shall” in this case has been replaced with “may.” Also new to this draft, DCA has clarified Section D to include more specifics on how and when cancellation and reimbursement terms must be delivered to applicants and customers. Comments are due Nov. 30.

• NJ reasonable assurance provision: The New Jersey Small Employer Health Benefits (SEH) Program finalized amendments to its regulation on “Small Employer Health Benefit Plans.” The final amendments include a new section on “Tie-ins” that addresses reasonable assurance. Specifically, the regulation requires carriers that do not embed pediatric dental benefits for small employer plans to obtain reasonable assurance that the small employer has purchased a qualified standalone dental benefit plan. The medical carrier cannot require, as a condition of sale, that the employer purchase any other insurance products.

• CO final network adequacy standards for dental plans: As an update to our previous article on Colorado network adequacy standards, the Division of Insurance (DOI) has issued final regulations on network adequacy standards for dental plans. The DOI also finalized standards and reporting requirements for health benefit plan provider directories, which the GRW does not believe applies to dental plans.

Federal: NADP’s member subgroup continues their review of the Department of Labor’s proposed new reporting requirements as part of an employer’s Form 5500. Members reviewed the extensive new requirements and NADP has created spreadsheets to better understand specific questions which are problematic and cannot be completed by dental plans. Comments are due Dec. 5.